Management of selected non-periodontal inflammatory, infectious and reactive conditions

Margherita Gracis; Alexander M. Reiter; Laura Ordeix

doi:10.22233/9781905319602.8

British Small Animal Veterinary Association , 172 (2018); https://doi.org/10.22233/9781905319602.8

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Management of selected non-periodontal inflammatory, infectious and reactive conditions

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Authors: Margherita Gracis, Alexander M. Reiter and Laura Ordeix
From: BSAVA Manual of Canine and Feline Dentistry and Oral Surgery
Item: Chapter 8, pp 172 - 195
DOI: 10.22233/9781905319602.8
Copyright: © 2018 British Small Animal Veterinary Association
Publication Date: September 2018

This chapter describes the diagnosis and treatment of a range of inflammatory conditions of the oral mucosa, jaws, masticatory muscles and salivary glands. Prevalence and clinical signs, aetiology, diagnostic evaluation and differential diagnosis, treatment and prognosis of specific conditions are considered in depth.

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Figures

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8.1

(a) Ulcerative gingivitis and alveolar, labial and buccal mucositis in a 1-year-old Domestic Shorthaired cat. (b) Chronic stomatitis (ST/CS) with the typical bilateral caudal inflammation in a 12-year-old Domestic Shorthaired cat. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.1 (a) Ulcerative gingivitis and alveolar, labial and buccal mucositis in a 1-year-old Domestic Shorthaired cat. (b) Chronic stomatitis (ST/CS) with the typical bilateral caudal inflammation in a 12-year-old Domestic Shorthaired cat. (© Dr Margherita Gracis)

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8.2

(a, b) A 4-year-old Domestic Shorthaired cat with bilateral caudal ulcerative stomatitis. (c, d) A year later, the same patient is unresponsive to partial-mouth tooth extraction (i.e. premolar and molar teeth) and different medical treatments. Note the severe bilateral ulcero-proliferative stomatitis, involving the caudolateral and ventrolateral surface of the tongue. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.2 (a, b) A 4-year-old Domestic Shorthaired cat with bilateral caudal ulcerative stomatitis. (c, d) A year later, the same patient is unresponsive to partial-mouth tooth extraction (i.e. premolar and molar teeth) and different medical treatments. Note the severe bilateral ulcero-proliferative stomatitis, involving the caudolateral and ventrolateral surface of the tongue. (© Dr Margherita Gracis)

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8.3

(a–d) Four different cats with stomatitis, showing progressively severe inflammation and ulceration of the mucocutaneous junctions. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.3 (a–d) Four different cats with stomatitis, showing progressively severe inflammation and ulceration of the mucocutaneous junctions. (© Dr Margherita Gracis)

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8.4

Ulceration of the labial philtrum in a 12-year-old, feline calcivirus (FCV)-positive and feline herpesvirus (FHV), feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV)-negative cat with stomatitis (ST/CS). (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.4 Ulceration of the labial philtrum in a 12-year-old, feline calcivirus (FCV)-positive and feline herpesvirus (FHV), feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV)-negative cat with stomatitis (ST/CS). (© Dr Margherita Gracis)

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8.5

A 4-year-old, feline calcivirus (FCV) and feline immunodeficiency virus (FIV)-positive, feline herpesvirus (FHV) and feline leukaemia virus (FeLV)-negative cat with stomatitis. (a, b) Bilateral caudal stomatitis, inflammation of the palatal mucosa adjacent to the dental arch and slightly asymmetrical proliferation of the palatoglossal folds. (c–e) Gingivitis and mucositis along the upper and lower dental arches. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.5 A 4-year-old, feline calcivirus (FCV) and feline immunodeficiency virus (FIV)-positive, feline herpesvirus (FHV) and feline leukaemia virus (FeLV)-negative cat with stomatitis. (a, b) Bilateral caudal stomatitis, inflammation of the palatal mucosa adjacent to the dental arch and slightly asymmetrical proliferation of the palatoglossal folds. (c–e) Gingivitis and mucositis along the upper and lower dental arches. (© Dr Margherita Gracis)

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8.6

(a, b) The same patient as in Figure 8.5 immediately following full-mouth tooth extraction. Adjunctive postoperative medical treatment included a short course of oral co-amoxiclav and topical application of 0.12% chlorhexidine gel. Two months after extraction, submucosal inoculation of recombinant feline interferon omega (rFeIFN-ϖ) was performed, followed by topical oromucosal administration for 3 months. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.6 (a, b) The same patient as in Figure 8.5 immediately following full-mouth tooth extraction. Adjunctive postoperative medical treatment included a short course of oral co-amoxiclav and topical application of 0.12% chlorhexidine gel. Two months after extraction, submucosal inoculation of recombinant feline interferon omega (rFeIFN-ϖ) was performed, followed by topical oromucosal administration for 3 months. (© Dr Margherita Gracis)

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8.7

(a–e) The same patient as in Figures 8.5 and 8.6 at the 8-month postoperative follow-up visit, showing resolution of the inflammatory lesions. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.7 (a–e) The same patient as in Figures 8.5 and 8.6 at the 8-month postoperative follow-up visit, showing resolution of the inflammatory lesions. (© Dr Margherita Gracis)

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8.8

(a–d) Severe periodontitis and contact mucositis in a 2.5-year-old Chartreux cat. (e, f) Fullmouth extraction. (g, h) Complete healing of the inflammatory lesions at the 3-week follow-up examination. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.8 (a–d) Severe periodontitis and contact mucositis in a 2.5-year-old Chartreux cat. (e, f) Fullmouth extraction. (g, h) Complete healing of the inflammatory lesions at the 3-week follow-up examination. (© Dr Margherita Gracis)

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8.9

Four dogs showing ulceration of the alveolar and buccal mucosa facing the right maxillary canine tooth with different degrees of plaque and calculus accumulation as well as periodontitis: (a) mild, (b, c) moderate, (d) severe. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.9 Four dogs showing ulceration of the alveolar and buccal mucosa facing the right maxillary canine tooth with different degrees of plaque and calculus accumulation as well as periodontitis: (a) mild, (b, c) moderate, (d) severe. (© Dr Margherita Gracis)

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8.10

(a) Loss of epithelium and filiform papillae along the lingual margin in an 11-year-old crossbreed dog. (b) Ulceration of the ventral surface of the tongue in an 11-year-old Yorkshire Terrier. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.10 (a) Loss of epithelium and filiform papillae along the lingual margin in an 11-year-old crossbreed dog. (b) Ulceration of the ventral surface of the tongue in an 11-year-old Yorkshire Terrier. (© Dr Margherita Gracis)

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8.11

(a) Severe periodontitis and contact ulcerations in an 11-year-old Basset Hound. (b) At the 1-year follow-up examination, showing complete healing of the ulcerative lesions following selective tooth extraction. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.11 (a) Severe periodontitis and contact ulcerations in an 11-year-old Basset Hound. (b) At the 1-year follow-up examination, showing complete healing of the ulcerative lesions following selective tooth extraction. (© Dr Margherita Gracis)

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8.12

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8.12 A 9-year-old Cocker Spaniel with bilateral generalized ulceration of the buccal mucosa. (© Dr Margherita Gracis)

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8.13

A 9-year-old Cocker Spaniel with chronic plaque-associated ulcerative stomatitis, showing dermatitis of the lower lip and loss of the mucocutaneous junction adjacent to the left mandibular canine tooth. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.13 A 9-year-old Cocker Spaniel with chronic plaque-associated ulcerative stomatitis, showing dermatitis of the lower lip and loss of the mucocutaneous junction adjacent to the left mandibular canine tooth. (© Dr Margherita Gracis)

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8.14

A 12-year-old Miniature Pinscher with chronic plaque-associated ulcerative gingivostomatitis complicated by necrosis. (a) Left buccal mucosa. (b) Left side of the tongue. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.14 A 12-year-old Miniature Pinscher with chronic plaque-associated ulcerative gingivostomatitis complicated by necrosis. (a) Left buccal mucosa. (b) Left side of the tongue. (© Dr Margherita Gracis)

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8.15

Ulcerative glossitis and stomatitis in an adult male crossbreed dog with toxic epidermal necrolysis associated with drug reaction to trimethoprim-sulfamethoxazole. (© Dr Fabia Scarampella) © 2018 British Small Animal Veterinary Association

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8.15 Ulcerative glossitis and stomatitis in an adult male crossbreed dog with toxic epidermal necrolysis associated with drug reaction to trimethoprim-sulfamethoxazole. (© Dr Fabia Scarampella)

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8.16

(a) Dorsal and (b) ventral views of ulcerative lesions on the tongue of a 9-year-old male Labrador Retriever affected by epitheliotropic T-cell lymphoma. (© Dr Laura Ordeix) © 2018 British Small Animal Veterinary Association

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8.16 (a) Dorsal and (b) ventral views of ulcerative lesions on the tongue of a 9-year-old male Labrador Retriever affected by epitheliotropic T-cell lymphoma. (© Dr Laura Ordeix)

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8.17

Traumatic occlusion and ulcero-proliferative lesion on the mucosa buccal to the left mandibular first molar tooth, in contact with the cusp of the maxillary fourth premolar tooth, in a 5-month-old male Chartreux cat. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.17 Traumatic occlusion and ulcero-proliferative lesion on the mucosa buccal to the left mandibular first molar tooth, in contact with the cusp of the maxillary fourth premolar tooth, in a 5-month-old male Chartreux cat. (© Dr Margherita Gracis)

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8.18

Oral eosinophilic granuloma in a 7.5-year-old neutered female Domestic Shorthaired cat. (a) Several nodular lesions are present on the tongue and palatoglossal folds (arrowed). (b) An extensive ulcerated plaque is also present on the upper lip. (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.18 Oral eosinophilic granuloma in a 7.5-year-old neutered female Domestic Shorthaired cat. (a) Several nodular lesions are present on the tongue and palatoglossal folds (arrowed). (b) An extensive ulcerated plaque is also present on the upper lip. (© Dr Margherita Gracis)

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8.19

Histopathology from a 3-year-old neutered female Domestic Shorthaired cat with an eosinophilic granuloma on the tongue, showing an eosinophil-rich mucosal infiltrate with granulomatous reaction and deeply embedded material suggestive of an insect part (arrowhead). (© Dr Laura Ordeix) © 2018 British Small Animal Veterinary Association

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8.19 Histopathology from a 3-year-old neutered female Domestic Shorthaired cat with an eosinophilic granuloma on the tongue, showing an eosinophil-rich mucosal infiltrate with granulomatous reaction and deeply embedded material suggestive of an insect part (arrowhead). (© Dr Laura Ordeix)

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8.20

Oral eosinophilic granuloma in a 1.5-year-old male Cavalier King Charles Spaniel, showing ulcerative nodules and plaques on the oral mucosa and palatoglossal folds with the characteristic whitish and yellowish surface (arrowed). (© Dr Margherita Gracis) © 2018 British Small Animal Veterinary Association

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8.20 Oral eosinophilic granuloma in a 1.5-year-old male Cavalier King Charles Spaniel, showing ulcerative nodules and plaques on the oral mucosa and palatoglossal folds with the characteristic whitish and yellowish surface (arrowed). (© Dr Margherita Gracis)

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8.21

Multiple oral papillomas in a 1-year-old male Jack Russell Terrier. Some warts were excised using a CO2 laser surgery unit (arrowed). (© Dr Laura Ordeix) © 2018 British Small Animal Veterinary Association

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8.21 Multiple oral papillomas in a 1-year-old male Jack Russell Terrier. Some warts were excised using a CO2 laser surgery unit (arrowed). (© Dr Laura Ordeix)

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8.22

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8.23

Papules (*) and a plaque (arrowed) on the tongue of an adult male crossbreed dog with leishmaniosis. (Courtesy of the Ophthalmology Service of Clinica Ars Veterinaria, Barcelona, Spain) © 2018 British Small Animal Veterinary Association

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8.23 Papules (*) and a plaque (arrowed) on the tongue of an adult male crossbreed dog with leishmaniosis. (Courtesy of the Ophthalmology Service of Clinica Ars Veterinaria, Barcelona, Spain)

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8.24

(a) Lingual calcinosis circumscripta in a dog. (b) A radiograph was taken of the excised tissue, showing a circumscribed lesion containing material with bone density that is arranged in lobules. (Reproduced from the BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery) © 2018 British Small Animal Veterinary Association

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8.24 (a) Lingual calcinosis circumscripta in a dog. (b) A radiograph was taken of the excised tissue, showing a circumscribed lesion containing material with bone density that is arranged in lobules. (Reproduced from the BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery)

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8.25

(a) Clinical image and (b) radiograph of the caudal aspect of the body of the right mandible in a 5-year-old entire male Labrador Retriever affected by multi-quadrant osteomyelitis and osteonecrosis. (© Dr Alexander M. Reiter) © 2018 British Small Animal Veterinary Association

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8.25 (a) Clinical image and (b) radiograph of the caudal aspect of the body of the right mandible in a 5-year-old entire male Labrador Retriever affected by multi-quadrant osteomyelitis and osteonecrosis. (© Dr Alexander M. Reiter)

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8.26

Same dog as in Figure 8.25 . (a) Tooth extraction and debridement down to bleeding bone and (b) suturing of the wound were performed. (c) Postoperative radiograph. (© Dr Alexander M. Reiter) © 2018 British Small Animal Veterinary Association

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8.26 Same dog as in Figure 8.25 . (a) Tooth extraction and debridement down to bleeding bone and (b) suturing of the wound were performed. (c) Postoperative radiograph. (© Dr Alexander M. Reiter)

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8.27

Same dog as in Figure 8.25 at the 8-month recheck examination. The previous surgery site was (a) inspected and(b) radiographed, showing healing. (© Dr Alexander M. Reiter) © 2018 British Small Animal Veterinary Association

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8.27 Same dog as in Figure 8.25 at the 8-month recheck examination. The previous surgery site was (a) inspected and(b) radiographed, showing healing. (© Dr Alexander M. Reiter)

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8.28

Dogs with masticatory muscle myositis (MMM). (a) A 3.5-year-old neutered female crossbreed dog presenting with acute swelling of masticatory muscles, exophthalmos and inability to open the mouth. (b) A 2-year-old, neutered female crossbreed dog presenting with chronic atrophy of masticatory muscles and enophthalmos. The dog’s muscle atrophy is exacerbated by the catabolic effect of glucocorticoid therapy. (© Dr Alexander M. Reiter) © 2018 British Small Animal Veterinary Association

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8.28 Dogs with masticatory muscle myositis (MMM). (a) A 3.5-year-old neutered female crossbreed dog presenting with acute swelling of masticatory muscles, exophthalmos and inability to open the mouth. (b) A 2-year-old, neutered female crossbreed dog presenting with chronic atrophy of masticatory muscles and enophthalmos. The dog’s muscle atrophy is exacerbated by the catabolic effect of glucocorticoid therapy. (© Dr Alexander M. Reiter)

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8.29

Transverse computed tomographic images in soft tissue algorithm of the head of the dog shown in Figure 8.28 (a) obtained at the level of the mandibular ramus. (a) This image was obtained prior to intravenous administration of contrast medium. (b) This image was obtained after intravenous administration of contrast medium. Note the marked inhomogeneous contrast enhancement in multiple masticatory muscles suggestive of inflammatory oedema and increased vascularity (*). The soft palate and blood vessels are normal. D = digastric muscle; M = masseter muscle; P = pterygoid muscle; SP = soft palate; T = temporal muscle. (© Dr Alexander M. Reiter) © 2018 British Small Animal Veterinary Association

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8.29 Transverse computed tomographic images in soft tissue algorithm of the head of the dog shown in Figure 8.28 (a) obtained at the level of the mandibular ramus. (a) This image was obtained prior to intravenous administration of contrast medium. (b) This image was obtained after intravenous administration of contrast medium. Note the marked inhomogeneous contrast enhancement in multiple masticatory muscles suggestive of inflammatory oedema and increased vascularity (*). The soft palate and blood vessels are normal. D = digastric muscle; M = masseter muscle; P = pterygoid muscle; SP = soft palate; T = temporal muscle. (© Dr Alexander M. Reiter)